ORAL MALODOR

Presented by
NIDHI SHARMA
INTERN
 Halitosis is a term used to describe noticeably unpleasant odor exhaled in breathing.

 It is also called breath malodor, foul breath and fetor oris.

 CLASSIFICATION
BASED ON

ETIOLOGY PATIENT’S CRITERIA

LOCAL FACTORS SYSTEMIC FACTORS  GENUINE HALITOSIS

-PHYSIOLOGIC HALITOSIS
-PATHOLOGIC HALITOSIS
 PSEUDOHALITOSIS
XEROSTOMIA  HALITOPHOBIA
 LOCAL FACTORS

PATHOLOGIC ORIGIN NON PATHOLOGIC ORIGIN

• Poor oral hygiene Stagnation of saliva associated with food debris
• Extensive caries , dentures and excessive smoking.
• Periodontal disease
• Cysts and tumors of aral
and pharyngeal cavities.

SYSTEMIC FACTORS

PATHOLOGIC ORIGIN NON PATHOLOGIC ORIGIN

• Diabetes mellitus Diet like garlic, onion, meat and meat products
• Liver failure and excessive alcohol consumption.
• Lung abcess
• tuberculosis
GENUINE HALITOSIS-Obvious malodor with intensity beyond socially acceptable level is perceived.

• PHYSIOLOGIC HALITOSIS
• Mouth breathing
• Medications
• Ageing and poor dental hygiene
• Fasting/ starvation
• Tobacco
• Foods {onion,garlic,etc.}
• alcohol
PATHOLOGIC HALITOSIS
Oral factors
• Periodontal infection- subgingival dental film and specific
diseases like ANUG
• Tongue coating harbour micro organisms
• Stomatitis and xerostomia
• Faulty restorations retaining food and bacteria
• Unclean dentures
• Oral cancer
• Candidiasis
• Parotitis and cleft palate
• Aphthous ulcer and dental abscesses
 Systemic and extra oral factors

• Nasal infections like rhinitis, sinusitis, tumors and foreign bodies.

• Diseases of GIT like hiatus hernia and GERD
• Pulmonary infection like bronchitis, pneumonia, TB, and carcinomas
• Certain hormonal changes during ovulation, pregnancy, menstruation and menopause
• Systemic diseases like diabetes mellitus, hepatic failure, renal failure, uremia , blood dyscrasias,dehydration and
cirrhosis of liver.

PSEUDOHALITOSIS-
Obvious malodor is not perceived by others, although the patient stubbornly complains of its existence.

HALITOPHOBIA-
Patient persists of having halitosis even after the treatment of halitosis.
 PATHOGENESIS
DIET, BACTERIA ,EPITHELIAL CELLS

PEPTIDES/PROTEINS

Proteolysis/hydrolysis

AMINO ACIDS
Aminolysis
PUTREFACTION PRODUCTS[Volatile sulfur
compounds containing methyl mercaptan,hydrogen
sulfide
 DIAGNOSIS
 Review of medical,dental and personal history

 Clinical examination.
• intraoral examination
-tongue coating
-evidence of mouth breathing
-xerostomia: dry mucosa
-other oral causes
• Complete periodontal examination
-general personal care
-probing for attachment levels, probing depths
-past history of dental hygiene care.

 Measurement of oral malodor

Patient instructed not to eat, chew, rinse or smoke for atleast 2 hours before examination.
patient who are on antibiotics should be seen 2 wks after discontinuation of medicines.
 SUBJECTIVE ORGANOLEPTIC
METHOD

 Organoleptic measurement is a sensory test scored on the

basis of the examiner’s perception of a subject’s oral
malodor.
 This has been used as a benchmarkfor oral malodor
measurement.
Organoleptic Scores (0- 5) By Rosenberg , Mulloch Et Al
1991.
0 - No appreciable odor

1 - Barely noticeable odor

2 - Slight but noticeable odor
3 - Moderate odor
4 - Strong odor
5 - Extremely foul odor
 GAS CHROMATOGRAPHY

 GC, performed with apparatus equipped with a flame photometric detector,

is specific for detecting sulphur in mouth air.

 It measures directly the three VSC methyl mercaptan, hydrogen sulfide

and
dimethyl sulfide.
 GC is considered the gold standard for measuring oral malodor
 This device can analyze air, saliva, crevicular fluid for a volatile
component.
 HALIMETERS

 Measure the level of sulfide gas found in person’s breath.

 Halimeter analyzes concentration of hydrogen sulfide and methyl-

mercaptan , but without discriminating between them.
BANA TEST- Benzoyl-Dl-arginine-naphthylamide
test
• Some ot the bacteria like Porphyromonas gingivalis,
Treponema denticola and Bacteroids forsythus produce
waste products that are quite odiferous and as a result
contribute in causing bad breath.
• These bacteria in question have the characteristic of being
able to produce an enzyme that degades the compound
benzoyl-dl-arginine naphthylamide.
• When a sample of proteins saliva that contains these bacteria
is placed within the BANA testing compound they cause it to
breakdown. As a result of this degradation, the test
compound changes its color indicating a positive reaction.
 Chemiluminescence
 This test involves mixing a sample containing sulfur compound[VSCs]
with the mercury
 Compound and the resultant reaction causes fluorescence.
 This test is highly sensitive as it can measure even the low levels of sulfur
compounds in the sample
DIAMOND PROBE [PERIO 2000 probe]

Sensors are integrated into the periodontal probe, so that the probe can be
placed directly into the periodontal pocket or on the tongue
 MANAGEMENT
Mechanical reduction of intraoral nutrients and micro-organisms

Professional periodontal
Tooth
therapy
brush
Tongue
cleaning

Chewing gum Inter-dental cleaning

 Masking the malodor

Mouth Lozenges
sprays containing
l volatiles

Chewing
gum

RINSES
 Herbal treatment

 Herbs and essential oils can be made into very effective mouthwash remedies to
sweeten breath, keep gums and teeth healthy. Fennel not only improves digestion, but also
can reduce bad breath and body odor that originates in the intestines.

 Cardamom tea contains cineole, a potent antiseptic that kills bad-breath bacteria and
sweetens breath.
 Thymol - antiseptic mouthwashes.

 Neem leaf powder – Anti plaque agent

 A few drops of lemon or peppermint

essential oils can be added to warm water for
an effective mouth rinse to freshen breath
 CONCLUSION

Breath malodor has important socioeconomic consequences and can reveal

important diseases. A proper diagnosis and determination of the etiology allow

initiation of the proper etiologic treatment.

THANK YOU